Question Of The Day: Medication and I.V. Administration

Q. A nurse is helping a physician insert a subclavian central line. After the physician has gained access to the subclavian vein, he connects a 10-ml syringe to the catheter and withdraws a sample of blood. He then disconnects the syringe from the port. Suddenly, the client becomes confused, disoriented, and pale. The nurse suspects an air embolus. She should:

A. place the client in a supine position and prepare to perform cardiopulmonary resuscitation.
B. place the client in high-Fowler's position and administer supplemental oxygen.
C. turn the client on his left side and place the bed in Trendelenburg's position.
D. position the client in the shock position with his legs elevated.

Correct Answer: C

Explanation: A nurse who suspects an air embolism should place the client on his left side and in Trendelenburg's position. Doing so allows the air to collect in the right atrium rather than enter the pulmonary system. The supine position, high-Fowler's position, and the shock position are therapeutic for other situations but not for air embolism. 

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Common Issues in Nursing Profession

The nursing occupation may be very rewarding however it's equally difficult. In some circumstances, there is a lack of common laws to deal with these points on the organizational, state, or nationwide stage. And issues come up since these points exist or after they intensify.

Right here’s a list of the nine issues that nurses universally face:

1. Staffing

As healthcare prices enhance, reducing the variety of employees nurses is usually seen because the logical option to fight it. Inadequate staffing and elevated job obligations each trigger issues and stress for nurses. That is very true for these employees nurses going through a wide range of affected person acuities. In response, some states have adopted laws to mandate a set nurse-to-patient ratio.

2. Inter-Professional Relationships

Conflicting views and feeling that you're being disrespected usually trigger issues. These conflicts in nursing relationships can come up between nurse and their sufferers, their co-workers, associate physicians, and directors.

3. Patient Satisfaction

Nurses are already stretched too skinny to accommodate staffing points. However, sufferers nonetheless have wants and expectations. Sadly, assembly these are tough. That is very true as healthcare circumstances change into extra continual, and the variety of personnel decreases.

4. On the Job Hazards and Job Security

Overflowing sharps containers and slippery flooring can pose dangers for employees members. Equally, lifting heavy sufferers can pose a bodily problem. And since we do work with these sufferers who're “sick,” there's a probability of contracting their sickness.

These hazards additionally embrace the conduct of different individuals. In some instances, nurses report feeling threatened by offended sufferers. That lack of respect and verbal abuse may additionally come from directors, physicians, and different members of the care staff.

5. Necessary Additional time

There are additional instances when nurses must go on necessary extra time. This may be the results of inadequate staffing ranges and excessively affected person acuity.

6. Ask the Nurse

We don’t know the whole lot about health care and associated diagnoses just because we're nurses. Nevertheless, family and friends nonetheless are happy to name us at any given hour to ask our perspective on a symptom or prescribed remedy, simply because we're within the nursing occupation.

7. Patient Relationships

It's simple to develop an in-depth relationship with our sufferers. When that affected person struggles and even dies, we feel their ache, and we feel that loss. So sustaining a wholesome, skilled relationship with the affected person is a should.

8. Advances in Technology

As expertise advances, so do our profession roles. For instance, with the expansion of the Web and smartphones, our roles and duties have modified. Documentation and databases are now mostly electronic. Utilizing Skype to speak can be frequent. As professionals, maintaining abreast with these advances is important.

9. Certification

Demonstrations of competence are a should. Sustaining continuing education hours and associated certifications are sometimes required. And whereas these equate to safer affected person care that adhere to finest practices, sustaining the required certifications are sometimes overwhelming while you’re juggling a full-time place and private obligations.

On high of this snapshot of dangers for the final practitioner, it's equally necessary to do not forget that every particular apply venue is totally different. Every specialty has its personal dangers. However, by being proactive and cognizant of those challenges, you may develop a greater plan of protection whereas within the nursing occupation.

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Question Of The Day: Basic Physical Care

Q. A client with burns on his groin has developed blisters. As the client is bathing, a few blisters break. The best action for the nurse to take is to:

A. remove the raised skin because the blister has already broken.
B. wash the area with soap and water to disinfect it.
C. apply a weakened alcohol solution to clean the area.
D. clean the area with normal saline solution and cover it with a protective dressing.

Correct Answer: D

Explanation:  The nurse should clean the area with a mild solution such as normal saline, and then cover it with a protective dressing. Soap and water and alcohol are too harsh. The body's first line of defense broke when the blisters opened; removing the skin exposes a larger area to the risk of infection.

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Question Of The Day: Respiratory Disorders

Q. The nurse has administered aminophylline to a client with emphysema. The medication is effective when there is:

A. Relief from spasms of the diaphragm.
B. Relaxation of smooth muscles in the bronchioles.
C. Efficient pulmonary circulation.
D. Stimulation of the medullary respiratory center.

Correct Answer: B

Explanation: Aminophylline, a bronchodilator that relaxes smooth muscles in the bronchioles, is used in the treatment of emphysema to improve ventilation by dilating the bronchioles. Aminophylline does not have an effect on the diaphragm or the medullary respiratory center and does not promote pulmonary circulation.

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Question Of The Day: Gastrointestinal Disorders

Q. A client with a bleeding ulcer is vomiting bright red blood. The nurse should assess the client for which of the following indicators of early shock?

A. Tachycardia.
B. Dry, flushed skin.
C. Increased urine output.
D. Loss of consciousness.

Correct Answer: A

Explanation: In early shock, the body attempts to meet its perfusion needs through tachycardia, vasoconstriction, and fluid conservation. The skin becomes cool and clammy. Urine output in early shock may be normal or slightly decreased. The client may experience increased restlessness and anxiety from hypoxia, but loss of consciousness is a late sign of shock.

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Basic Principles of Nursing Administration

Basic Principles of Nursing Administration - In the world of nursing course, the implementation of nursing administration is one of the main things that affect all of the nursing processes. And nursing actions and all things related to nursing cannot be separated from this nursing administration. This time of Nursing blog will try to share a little about the administration of nursing and hopefully useful and can provide benefits.

The process by the nursing administration of open systems approach in which each of the components are interrelated and interact and be influenced by the environment. Because it is a system that will consist of five elements of input, process, output, control and feedback mechanisms.

Input from the nursing administration among other information, personnel, equipment, and facilities. The process in nursing administration is the manager of the highest level of nursing administration to implementing nurse have a duty and authority for planning, organizing, directing and monitoring the implementation of the nursing service. The output is nursing care, staff development, and research.

Controls used in the budget process, including nursing administration of the nursing, nursing job performance evaluations, standards and accreditation procedures. The feedback mechanism in the form of financial statements, an audit of nursing, quality control and performance survey of nurses.

The principles underlying nursing administration are:

1. The nursing administration should be based on planning because through the planning, leaders can reduce the risk of decision-making, effective problem solving and planning.

2. Nursing administration implemented through the effective use of time. Nursing managers who appreciate the time will develop a well-rounded program planning and implement activities by a pre-determined time.

3. The nursing administration will involve decision making. Various situations and problems that occur in the administration of nursing activities require decision-making at various managerial levels.

4. Meet the nursing care needs of patients is the focus of attention of the nurse manager to consider what the patient saw, thought, believe and desire. Patient satisfaction is the main point of the whole purpose of nursing.

5. The nursing administration should be organized. Organizing conducted by the needs of the organization to achieve goals.

6. The briefing is an element of nursing administration activities covering the delegation, supervision, coordination and control of the implementation of the plans that have been organized.

7. Good nursing division motivates employees to demonstrate a good working performance.

8. Nursing administration using effective communication. Effective communication will reduce misunderstandings and provide shared vision, direction, and understanding among employees.

9. Staff development is important to be implemented as a preparatory effort implementing nurses occupy a higher position or manager attempts to improve employee knowledge.

10. Control is an element of nursing administration that includes an assessment of the implementation of the plan has been created, providing instruction and establish principles - principles through standard-setting, comparing performance with standards and correct deficiencies

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Question Of The Day: Postpartum Period

Q. The nurse is caring for several mother-baby couplets. In planning the care for each of the couplets, which mother would the nurse expect to have the most severe afterbirth pains?

A. G 4, P 1 client who is breastfeeding her infant.
B. G 3, P 3 client who is breastfeeding her infant.
C. G 2, P 2 cesarean client who is bottle-feeding her infant.
D. G 3, P 3 client who is bottle-feeding her infant.

Correct Answer: B


Explanation: The major reasons for afterbirth pains are breast-feeding, high parity, overdistended uterus during pregnancy, and a uterus filled with blood clots. Physiologically, afterbirth pains are caused by intermittent contraction and relaxation of the uterus. These contractions are stronger in multigravidas in order to maintain a contracted uterus. The release of oxytocin when breast-feeding also stimulates uterine contractions. There is no data to suggest any of these clients has had an overdistended uterus or currently has clots within the uterus. The G 3, P 3 client who is breast-feeding has the highest parity of the clients listed, which—in addition to breast-feeding—places her most at risk for afterbirth pains. The G 2, P 2 postcesarean client may have cramping but it should be less than the G 3, P 3 client. The G 3, P 3 client who is bottle-feeding would be at risk for afterbirth pains because she has delivered several children, but her choice to bottle-feed reduces her risk of pain.

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Question Of The Day: Antepartum Period

Q. A pregnant client in her third trimester is started on chlorpromazine (Thorazine) 25 mg four times daily. Which of the following instructions is most important for the nurse to include in the client's teaching plan?

A. "Don't drive because there's a possibility of seizures occurring."
B. "Avoid going out in the sun without a sunscreen with a sun protection factor of 25."
C. "Stop the medication immediately if constipation occurs."
D. "Tell your doctor if you experience an increase in blood pressure."

Correct Answer: B

Explanation: Chlorpromazine is a low-potency antipsychotic that is likely to cause sun-sensitive skin. Therefore the client needs instructions about using sunscreen with a sun protection factor of 25 or higher. Typically, chlorpromazine is not associated with an increased risk of seizures. Although constipation is a common adverse effect of this drug, it can be managed with diet, fluids, and exercise. The drug does not need to be discontinued. Chlorpromazine is associated with postural hypotension, not hypertension. Additionally, if postural hypotension occurs, safety measures, such as changing positions slowly and dangling the feet before arising, not stopping the drug, are instituted.

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Hydration for Nurses

A nurse's hydration status has a major influence on career performance.There is nothing like a long shift at the hospital to make a nurse feel like a raisin. The struggle to maintain hydration during a ten hour shift has been getting the best of me. I noticed toward the end of my ER shift a few worrisome symptoms: cottonmouth, headache, foggy brain, leg cramps and joint pain. My brain struggles to remain engaged and body feels like it's moving through molasses.

The Problem

Usually, I went into very shift with my gas tank nearly empty. I drank fluids when I felt thirsty or needed a caffeine jolt. The few times I drank water, I found myself constantly rushing to the restroom. We all know we cannot keep rushing to the restroom when caring for sick patients. I am expected to react promptly to a dynamic work environment that is constantly influx. Response to a demanding work environment relies on having a full gas tank. Nurses can survive without food and voiding but, they cannot live without water.

Looking for Answers

The search was on to find a few interventions to correct the hydration problem. The goal is to find a few small changes that produce maximum results. After a literature review I unearthed some compelling research based practices. Dr. Stacey Sims is a forward thinking scientists that is changing the sports world’s views about hydration. She is environmental exercise physiologist and nutrition scientists. Dr. Sims helps elite endurance athletes reach their professional goals. Her research highlight the factors that influence the small intestine water absorption. The main message is the majority of water is absorbed when the small intestine contents register just above plasma osmolarity. The balance of protein, high-water content fruits/vegetables, and lightly salted meals facilitate water transport into the bloodstream. Do not underestimate power of osmosis and the osmotic gradient. Dr. Sims recommends a few changes to boost one’s optimum performance. I could not just take a scientist’s word for it. I had to see it for myself. So I put a few hydration and nutrition tweaks into action.

Do’s

10ml x individual’s weight (kg)= ml of water with a pinch of himalayan salt (night prior to work or 2.5 hours prior to work)

Protein drink (15-30 gm) within 30 minutes from waking up

Each meal includes fruit or vegetable with high-water content ie: grapes, strawberries, raspberries, peaches, zucchini, peppers, celery, broccoli, cabbage

Lightly salt meals if you have no dietary restrictions

Drink lightly salted water with every meal (add pinch of himalayan salt to your water bottle)

Becoming the Guinea Pig

After a few weeks of implementing these interventions, I was reaping the physical benefits. I thought these improvements were all in my head. So, I decided to go back to my old ways. I drank water only when thirsty and guzzled the soda down before I could think twice. I paid for these hasty decisions for the rest of the shift. The fog rolled over my brain. It took ten times the energy to care for my patients. Driving home I kept asking myself was it worth it? Nope. The sugar high didn’t last as long the foggy brain.

Don’ts

Avoid drinking high sugar drinks ie: sports drinks, soda, coconut water.

Juicy Grape 

Today, I felt like a juicy grape. I am more agile to attack the mental and physical demands of my work day. The physical gains makes it easier to multi-task and move swiftly throughout the work day. The focus is to keep my hydration and nutrition on point during the workweek. I love looking at the ER experience as a fun obstacle course full of twist and turns. The well prepared professional has the best race.

My Massive Gains

Decrease fatigue

Decrease headaches

Decreased joint pain

Heightened multi-tasking capacity

Improved career satisfaction when feeling physically strong

Sharing Life Hacks

Maybe you have the same struggles and looking for some answers. I’d like to pass on any tools that can help your professional performance. I encourage you to try these small interventions and see how you feel.

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Question Of The Day: Psychotic Disorders

Q. A client with bipolar disorder, manic phase, just sat down to watch television in the lounge. As the nurse approaches the lounge area, the client states, "The sun is shining. Where is my son? I love Lucy. Let's play ball." The client is displaying:

A. Concreteness.

B. Flight of ideas.

C. Depersonalization.

D. Use of neologisms.

Correct Answer: B

Explanation: The client is demonstrating flight of ideas, or the rapid, unconnected, and often illogical progression from one topic to another. Concreteness involves interpreting another person's words literally. Depersonalization refers to feelings of strangeness concerning the environment or the self. A neologism is a word made up by a client.

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Professional Growth in Nursing

Nurses are anticipated to acknowledge and reply to a plethora of latest calls for arising from an ever-changing and more and more complicated healthcare system. Some new laws and accreditations processes, skilled requirements, elevated accountabilities, and financial priorities require extra of direct care nurses and nurse leaders already struggling to realize and maintain competencies in evolving areas of observing, high quality, and secure affected person care. At present’s politico-societal healthcare environments embody rising shifts and disconnects in affected person care wants and the provision of human, materials, and financial sources required to satisfy these wants.

Nursing professional growth specialists are the keys to effective succession planning, managing competing priorities, and affecting value avoidance. These practitioners are greater than educators. They emphasize security, high quality, effectively, and effectiveness of observing whereas quickly transitioning numerous generations of nurses into observing. They perceive grown up studying ideas, profession improvement in healthcare and communities of observe, persevering with schooling program improvement and administration, transformational/servant management (Keith 2008), techniques redesign, advanced implementation, and strategic planning. 

The American Nurses Affiliation (2009b) distinguishes Nursing Professional Development (NPD) as knowledgeable specialty primarily based on the sciences of nursing, know-how, analysis and evidence-based observe practice-based proof, change, communication, management, and schooling.

NPD specialists advise, collaborate, translate, combine, and consider nursing and medical analysis that's within the literature and in progress throughout the group via following, training, and reflective dialogue with workers and inter-professional companions. Within the function of the servant chief, NPD specialists present encouragement, respect, help, boundaries, safety, advocacy, guidance, and mentorships that affect nurses’ transition into autonomous, skilled nurses. They combine moral rules, service, and management into all of their actions, position modeling transformational management, and professionalism that entice nurses to take dangers, share in decision-making, and discover their potential.

The roles and accountabilities of NPD reflect the distinctive data, expertise, insights, and experiences of nurses who've superior their apply into employees growth, persevering with training, and academia on a worldwide scale. Right, this moment’s evolving expertise and the shifting schooling platforms used to organize nurses for skilled observe are mirrored within the expanded studying wants of latest graduates and seasoned nurses alike. 

NPD specialists work with a variety of competencies, studying wants, and tiered academically ready nurses throughout all apply settings and environments of care. They associate with healthcare suppliers and nurse leaders to make sure a protected, efficient, and environment-friendly atmosphere of care. They're concerned in challenge administration, educational and scientific training, program and portfolio growth, competencies administration, persevering with schooling and return on funding, management and relationship-building, analysis and evidence-based observe implementation, cybergoth (studying using know-how), and nursing observes excellence. They do all of this and extra for the present and future of professional nursing.

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Ethics and Values in Nursing

Every profession has their very own code of ethics, together with nursing. This lesson will stroll you through the nine provisions of the nursing code of ethics and how one can interpret these in your personal practices.

Code of Ethics for Nurses

Would not it be nice if we by no means needed to make tough choices? If we by no means needed to take care of controversy or advocate for what's proper within the face of hostility? Sadly, the nursing occupation isn't immune to those sorts of conditions, and there'll come a time in any nursing profession the place a path must be chosen. Following the Code of Ethics for Nurses will assist you to select the correct one.

The American Nurses Association (2014) states: 'the Code of Ethics for Nurses was developed as an information for finishing up nursing duties in a way in step with high quality in nursing care and the moral obligations of the career.' After years of revising, the preliminary Code for Nurses was developed in 1985. TheAmerican Nurses Association House of Delegates accepted the ultimate draft in June 2001, which included nine provisions and was termed the Code of Ethics for Nurses.

When working within the service business, a code of ethics is a basic doc that, in essence, is a settlement between these being served and people who are serving. It additionally offers route and help when the precise determination is not at all times apparent. In a occupation the place the stakes are excessive, robust choices will inevitably be made sooner or later, and that is the place it will get difficult. Our lives are interchanging, and our skilled ethics are usually not the identical as our private ethics and, at occasions, might battle.

Our private code of ethics, or our conscience, drives us to be our greatest in our non-public lives, whereas our skilled ethics drive us to be our greatest in our careers. However which one wins out when we have now to desert one or the opposite? As nurses, the reply could not all the time be clear, so let's take a better take a look at the nine provisions set forth by the American Nurses Association.

The American Nurses Association (ANA) initiated its Code of Ethics challenge in 1995. An activity power was charged with establishing a complete strategy of evaluating, evaluation and revision of the 1985 Code for Nurses. In June of 2001, the ANA Home of Delegates voted to simply accept the nine main provisions of a revised Code of Ethics and in July 2001 the revised and ensuing Code of Ethics for Nurses With Interpretive Assertion was launched.

1. The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, price, and uniqueness of each particular person, unrestricted by concerns of social or financial standing, private attributes, or the character of well-being issues.
2. The nurse’s major dedication is to the affected person, whether or not a person, household, group, or group.
3. The nurse promotes, advocates for, and strives to guard the good-being, security, and rights of the affected person.
4. The nurse is accountable and accountable for particular person nursing follow and determines the suitable delegation of duties in keeping with the nurse’s obligation to supply optimum affected person care.
5. The nurse owes the identical duties to self as to others, together with the duty to protect integrity and security, to take care of competence, and to proceed private and professional progress.
6. The nurse participates in establishing, sustaining, and enhancing well-being care environments and situations of employment conducive to the supply of high-quality well-being care and in step with the values of the career by a particular person and collective motion.
7. The nurse participates in the development of the occupation using contributions to observing, training, administration, and data improvement.
8. The nurse collaborates with the different well-being professionals and the general public in selling neighborhood, nationwide, and worldwide efforts to fulfill well being wants.
9. The career of nursing, as represented by associations and their members, is chargeable for articulating nursing values, for sustaining the integrity of the career and its follow, and for shaping social coverage.

It's straightforward, and it sounds easy sufficient to comply with. Nevertheless, every single day nurses encounter moral points. In our present healthcare period, the issues we can do aren't all the time the issues we must always do or are greatest for our patients and their households. It's our job as nurses to assist our patients, to take care of them. We're the one ones obtainable, significantly as life's beginnings and endings, when patients are unable to talk for themselves, to assist make these selections. Having a code of ethics to fall again on will help strengthen our voices and supply a framework for the choice making the course of.

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Question Of The Day: School-age Child

Q. A 7 year old with a history of tonic-clonic seizures has been actively seizing for 10 minutes. The child weighs 22 kg and currently has an intravenous (IV) line of D5 1/2 NS + 20 meq KCL/L running at 60 ml/hr. Vital signs are a temperature of 38 degrees C, heart rate of 120, respiratory rate of 28, and oxygen saturation of 92%. Using the SBAR (Situation-Background-Assessment-Recommendation) technique for communication, the nurse calls the primary healthcare provider with a recommendation for:

A. Rectal diazepam (Diastat).
B. IV lorazepam (Ativan).
C. Rectal acetaminophen (Tylenol).
D. IV fosphenytoin.

Correct Answer: B

Explanation: IV ativan is the benzodiazepine of choice for treating prolonged seizure activity. IV benzodiazepines potentiate the action of the gamma-aminobutyric acid (GABA) neurotransmitter, stopping seizure activity. If an IV line is not available, rectal Diastat is the benzodiazepine of choice. The child does have a low-grade fever; however, this is likely caused by the excessive motor activity. The primary goal for the child is to stop the seizure in order to reduce neurologic damage. Benzodiazepines are used for the initial treatment of prolonged seizures. Once the seizure has ended, a loading dose of fosphenytoin or phenobarbital is given. 

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Effect of Comfort, Rest and Sleep on Nurse Performance

More research is indeed to explain the effect of “fatigue” and “sleepiness” on the performance of nurse. Sleepiness refers to a bent to go to sleep, whereas fatigue refers to an awesome sense of tiredness, lack of vitality, and a sense of exhaustion related to impaired bodily and/or cognitive functioning. Sleepiness and fatigue typically coexist as a consequence of sleep deprivation.

Though fatigue could be resulting from a wide range of causes (e.g., sickness, a vigorous exercise, or an interval of extended focus), this chapter will give attention to the consequences of fatigue related to inadequate sleep (see Key Phrases and Definitions). The effect of prolonged work shifts and the connection of those work schedules to nurse and affected person security can even be explored.

Results of Inadequate Sleep

Though the precise quantity of sleep wanted by wholesome adults has not been decided, the results of inadequate sleep have been nicely documented. A evaluate of the related literature over the previous 15 years reveals that inadequate sleep (or partial sleep deprivation) has quite a lot of hostile results. Regardless of the big selection of analysis methodologies (e.g., qualitative research, surveys and scientific trials, devices) and settings (e.g., discipline research, and time-isolation laboratories, and pattern sizes), the outcomes are fairly related: inadequate sleep has been related to cognitive issues, temper alterations, decreased job efficiency, decreased motivation, elevated security dangers, and physiological modifications. Outcomes from laboratory research of complete sleep deprivation (a number of nights without sleep) weren't included on this evaluation, because the focus of this part is on inadequate sleep (partial sleep deprivation) and never on complete sleep deprivation.

Prolonged Work Hours

Though the hazards related to the extended hours labored by resident physicians and interns have been documented in quite a few research, restricted consideration has been paid to the hours labored by nurses or the results of those hours on affected person security. Early research tended to give attention to nurse satisfaction with the brand new 12-hour shift schedule, solely minimally addressing the elevated threat of errors. More modern research, nevertheless, have proven that the 12-hour shifts favored by many nurses and frequent time beyond regulation are related to difficulties staying awake on obligation, lowered sleep occasions, and almost triple the chance of creating an error.

Consecutive Shifts

Fatigue will be exacerbated with elevated numbers of shifts labored with out a time off, and dealing greater than 4 consecutive 12-hour shifts is related to extreme fatigue and longer restoration occasions. Folkard and Tucker additionally advised that the buildup of fatigue over successive work shifts would possibly clarify the rise in accident charges noticed of their meta-analysis. On common, threat of an accident was roughly 2 p.c increased on the second morning/day shift; 7 p.c larger on the third morning/day shift, and 17 p.c increased on the fourth morning/day shift than on the primary shift. Accident dangers additionally elevated over successive evening shifts (e.g., on common threat was 6 % increased on the second evening, 17 % larger on the third night time, and 36 p.c larger on the fourth evening) and have been considerably greater than on day/morning shifts, a discovering much like that reported by Haeckel and colleagues a number of years earlier.

Conclusion

The evidence is overwhelming that nurses who work longer than 12 consecutive hours or work once they haven't obtained adequate sleep are placing their sufferers’  health in danger; threat damaging their very own health; and in the event that they drive residence when they're drowsy, additionally put the health of most of the people in danger. Nurses, nurse managers, nursing directors, and policymakers have to work collectively to alter the tradition that not solely permits, however typically encourages nurses to work lengthy hours without acquiring ample sleep.

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Question Of The Day: Infant

Q. A 10-month-old child with recurrent otitis media is brought to the clinic for evaluation. To help determine the cause of the child's condition, the nurse should ask the parents:

A. "Does water ever get into the baby's ears during shampooing?"
B. "Do you give the baby a bottle to take to bed?"
C. "Have you noticed a lot of wax in the baby's ears?"
D. "Can the baby combine two words when speaking?"

Correct Answer: B

Explanation: In a young child, the eustachian tube is relatively short, wide, and horizontal, promoting drainage of secretions from the nasopharynx into the middle ear. Therefore, asking if the child takes a bottle to bed is appropriate because drinking while lying down may cause fluids to pool in the pharyngeal cavity, increasing the risk of otitis media. Asking if the parent noticed earwax, or cerumen, in the external ear canal is incorrect because wax doesn't promote the development of otitis media. During shampooing, water may become trapped in the external ear canal by large amounts of cerumen, possibly causing otitis external (external ear inflammation) as opposed to internal ear inflammation. Asking if the infant can combine two words is incorrect because a 10-month-old child isn't expected to do so.

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Role of Nursing in Pain Management

Pain management is an integral a part of nursing. And we've got an accountability to successfully handle our patients’ pain. However this doesn't at all times imply the usage of an analgesic. Efficient pain administration might be holistic in its approach. The secret is to have a routine that's protected, sensible, and possible within the outpatient setting.

What Is Pain?

Primarily, pain is the results of a sign dispatched from the peripheral nerves to the mind. This sign is, in impact, a survival mechanism that enables one to know that the scenario isn't conducive to homeostasis. The sign continues, and this equates to continual pain.

Pain, whether acute or chronic, can change one’s life. However do not forget that regardless of the depth, there are remedy choices. And, we as nurses have an accountability to current these choices to our patients. We even have the accountability to make sure that patients are supplied with pain administration educations, to make sure that pain administration issues are documented, and that applied therapy modalities (together with their corresponding outcomes) are recorded.

So, consider the next situation:

Your patient is scheduled to be discharged today, and throughout the course of her in-patient keep, efficient pain administration has been a precedence and a problem. At present, on the time of discharge, she is ready to successfully handle her pain with a non-narcotic analgesic given each Four-6 hours. What different methods are you able to share along with her to assist her with pain administration at dwelling? What must be documented associated to pain administration?

First, take into account documentation associated with pain administration. The Joint Fee mandates that pain is assessed and reassessed. It's also a requirement (thejointcommission.org/pain management) that interventions and their efficacy be documented. The documentation of training associated with pain administration can also be a requirement.

However managing our patients’ pain doesn't merely equate with the administration of an analgesic. As you intervene in pain administration, contemplate the next methods which might be useful:

➦ Consult with the other members of the care group. Nurses are an integral a part of the care group. Subsequently, if the present routine is just not efficient, doc it as such and seek the advice of with the doctor. If wanted, it's prudent to suggest the session with a pain administration specialist. Equally, if the affected person is comparatively near being discharged, current the choice of shifting to a non-narcotic analgesic.
➦ Collaborate with the pharmacy. If the affected person has been accustomed to a potent narcotic for pain administration, think about different options.
➦ Encourage follow-up care. After discharge, follow-up care, associated with pain administration, is essential. This may imply the referral to a pain administration specialist or follow-up with a major doctor.
➦ Educate life-style strategies. As an example, in case your affected person is scheduled for out-patient bodily remedy, instruct her or him to take the analgesic earlier than the exercise. Also teach side effects related to the medication.
➦ Preserve a pain diary. Recording what interventions are efficient and what actions trigger pain is a useful technique. Together with the report of exercise, the pain can be described. As an example, is the pain sharp or uninteresting? Document what interventions are efficient. It additionally useful to notice if there's an explicit time of the day when the pain is worse.
➦ Maintain an exercise file. Recording what actions make the pain higher or worse can be helpful, and this may give the opposite care workforce members an thought of the correlation between pain and exercise.
➦ Bodily remedy and occupational remedy. These therapies also need to be introduced on board when trying to efficiently handle pain.
➦ Present actions to alleviate pain. Actions similar to yoga, strolling, acupuncture have all been confirmed efficient in pain discount. Biofeedback, yoga, and rest are further actions to think about, and their incorporation is commonly important to an efficient pain routine.
➦ Focus on the significance of relaxation. Intervals of relaxation are a necessity. It's worthwhile to recommend that after taking an analgesic the affected person ought come to relaxation. Relaxation permits the physique time to rejuvenate, and it's efficient for the patients’ emotional well-being.
➦ Think about dietary modifications. For some, sure dietary supplements, resembling fish oil, are efficient. Conversely, some dietary components worsen pain. As an illustration, for this fighting gout or migraines, purple wine, and/or sure cheeses can set off an assault.

We're our patients’ ally within the administration of their pain. Due to this fact, it's essential to recollect to not solely implement the methods listed above but also bear in mind to the doc the efficacy of every intervention. And doc every instructing together with the affected person’s response.

Without query, uncontrolled pain may end up with devastating effects. Do not forget that efficient pain administration calls for the eye of all members of the care workforce. We spend an excessive amount of time with our patients they usually rely upon our information and experience. By thinking critically, by utilizing our sources, by speaking with our patients, by being thorough in our analysis, and by being relentless in our efforts, we will make an astounding distinction in our patients’ expertise of pain.

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Essential Nutrition for Nurses

Nurses take care of people every day in many settings such as hospitals, doctor workplaces, colleges, and public health services. Such positions typically require nurses to work variable and lengthy hours, exposing them to the stressors of caring for people who find themselves in poor health. These stressors can assist poor meals selections that adversely have an effect on the health and well-being of the nurse. Nurses are additionally an integral a part of offering nutrition-related data to patients. As such, patients could also be very cognizant of the health habits of their nurses. Consuming for good health is a method that nurses can scale back the effect of stressors on the physique and positively affect their health, permitting them to raised look after patients and themselves.

Nurses play an integral role in healthcare whether or not they're working on the affected person bedside, caring for patients in a doctor workplace, or offering care and training as a part of public health. They're caregivers, lifesavers, cheerleaders, confidants, trusted assets, and a lot extra. Because of this, it's so vital for nurses to deal with themselves as properly. Nurses can profit from good, sound vitamin to assist them to lead wholesome lives.

As nurses look after folks, they could face some occupational and personal stressors, such as caring for patients who're severely sick, sleep deprivation as a consequence of variable and lengthy work schedules, and addressing household obligations. It's not tough to think about why nurses typically place the health of others earlier than their very own health. However, that is the place a change in thought is required. When healthcare professionals, resembling nurses, take care of their very own health, it's cheap to assume that it will assist them to higher look after patients. The good vitamin is a straightforward but integral a part of wholesome habits that may be simply integrated into the everyday routine of a nurse. For instance, wholesome meals selections might assist to handle stressors, keep weight at a wholesome degree, and enhance power ranges.

Along with the significance of diet for the excellent health of nurses, it's usually nurses who present vitamin evaluation and training to patients. On this function, they supply details about vitamin to patients but additionally function position fashions.

Consuming for good health is one essential means that nurses can scale back the impression of stressors on the physique and positively affect their health, hopefully enhancing their satisfaction with each work and life. This text opinions two frequent diet associated areas of concern to nurses, stressors, irritation, and diet and sleep and consuming patterns that may result in weight problems. Data and attitudes about vitamin training are additionally briefly mentioned. Lastly, the article affords an overview of diet fundamentals for nurses and recommendations to keep away from potential meals pitfalls frequent for nurses.

It's time for nurses to deal with themselves and one side of that care is a sweet vitamin. As mentioned in this article, there are various methods to realize a nutritious diet.  However, the backside line is that consistency of vitamin intakes, portion sizes, and selection are integral methods for managing private diet and health. Empowering nurses with data about how diet impacts the human physique and the way wholesome meals selections can enhance their private health will hopefully assist them to embrace optimistic consuming habits. When nurses have wholesome habits, reminiscent of a diversified weight loss program and sufficient sleep, they, too, can feel higher and reduce the danger of creating continual ailments.

Nurses are on the frontline in healthcare; as they undertake healthy living practices, the patients they look after could also be extra inclined to undertake wholesome selections as effectively. The objective of any healthcare supplier is to enhance the lives of different folks. Nurses can try this much more successfully by taking the lead and deciding that wholesome dwelling is as vital to them as it's for the folks they take care of every day.

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Question of the Day: The Nursing Process

Q. During rounds, a nurse finds that a client with hemiplegia has fallen from the bed because the nursing assistant failed to raise the side rails after giving a back massage. The nurse assists the client to the bed and assesses for injury. As per agency policies, the nurse fills out an incident report. Which of the following activities should the nurse perform after finishing the incident report?

 A. Attach a copy to the client's records.
 B. Highlight the mistake in the client's records.
 C. Include the time and date of the incident.
 D. Mention the name of the nursing assistant in the client records.

Correct Answer: C

Explanation: The nurse should include the date and time of the incident in the incident report, the events leading up to it, the client's response, and a full nursing assessment. To prevent legal issues, the nurse should not attach the copy of the incident report to the client's records. Also to prevent litigation, the mistake should not be highlighted in the client's records. As the client report is a legal document, it should not contain the name of the nursing assistant.

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Nursing challenges in today’s world

Nurses play an integral role within the healthcare business, offering care to the patient and filling management roles at hospitals, health programs, and different organizations.However being a nurse will not be without its challenges. It is a demanding career that requires a whole lot of dedication and dedication.

Listed here are 5 large points dealing with nurses at present.

1. Compensation. Relating to nurse compensation, regional variations are to be anticipated primarily based on the price of residing.

Nurses dwelling insure areas of the U.S. make way more than nurses in different areas, based on the Affiliation of periOperative Registered Nurses group.

Nurses within the Pacific area make about $18,000 greater than the typical worker's nurse, for example. Subsequent is the Mid-Atlantic area; the place nurses make $14,800 greater than common. Nurses within the East South Central area, nevertheless, make $four,300 lower than common.

Past regional variations in pay, nurse pay gaps additionally persist between genders.

Male registered nurses earn, on common, upwards of $5,000 greater than their feminine counterparts. The gender pay hole is current in all specialties besides orthopedics, by a examine printed in JAMA. Amongst nurse specialties, power care had the smallest gender pay hole, at $three,792, and cardiology had the best hole, at $6,034.

2. Workplace violence. One other main problem nurses face is violent habits whereas on the job, be it from patient or coworkers.

Between 2012 and 2014, workplace violence harm charges elevated for all healthcare job classifications and almost doubled for nurse assistants and nurses, in response to information from the Occupational Health Security Community. A complete of 112 U.S. amenities in 19 states reported 10,680 Occupational Security and Health Administration recordable accidents occurring from January 1, 2012, to September 30, 2014. There have been four,674 affected person dealing with and motion accidents; three,972 slips, journeys and falls; and a pair of,034 workplace violence accidents.

This year, North Carolina took a stance in opposition to workplace violence. Beginning Dec. 1, individuals who assault hospital staff in North Carolina could be charged with a felony, because of a brand new state legislation. Information reported that the brand new regulation handed by "massive margins" and was signed into regulation final month.

Different states are additionally cracking down on workplace violence: In Massachusetts, the Massachusetts Nurses Affiliation union is pushing a workplace violence invoice that will add enhanced plans round workplace security.

3. Short staffing. Staffing is a matter of each skilled and private concern for nurses right this moment. The truth is, points associated with staffing ranges, unit group or inequitable assignments are one of many high causes nurses depart a hospital job, by Karlene Kerfoot, Ph.D., RN, VP of nursing for API Healthcare.

Again in June, the Health Coverage Fee unanimously accredited a mandate on nurse staffing in intensive care units all through Massachusetts. The laws require that nurses in intensive care units in hospitals, together with hospitals operated by the Massachusetts Division of Public Health, be assigned solely as much as two patient at a given time. The laws apply to all ICUs, together with particular units for burn patient, youngsters, and untimely infants.

If staffing is insufficient, nurses contend it threatens affected person health and security, leads to better complexity of care and impacts their health and security by growing fatigue and charge of damage.

Certainly, a Minnesota Division of Health evaluates of literature discovered robust proof linking decreased nurse staffing ranges to increased affected person mortality, failure to rescue and falls within the hospital. There was additionally robust proof that different care course of outcomes resembling drug administration errors, missed nursing care and affected person size of the keep are linked to decreasing nurse staffing ranges.

Moreover, a examine in Health Affairs discovered that insufficient staffing could hinder nurses' efforts to hold out processes of care. Researchers discovered that hospitals with greater nurse staffing had 25 % decrease odds of being penalized below the Reasonably priced Care Act's Hospital Readmissions Discount Program in comparison with in any other case related hospitals with decrease staffing.

That is why unionized nurses usually convey up staffing ranges when they're in the course of contract negotiations. For example, dozens of nurses protested Aug. three exterior of St. Petersburg (Fla.) Normal Hospital over staffing ranges and wages. Moreover, nurses and different healthcare employees deliberate to carry a picket July 15 exterior Renton, Wash.-based Valley Medical Heart over staffing ranges.

4. Lengthy working hours. Nurses are sometimes required to work lengthy shifts. However, in various instances, nurses should work back-to-back or prolonged shifts, risking fatigue that might end in medical errors.

2012 examine printed in Health Affairs discovered that the longer the shifts for hospital nurses, the upper the degrees of burnout and affected person dissatisfaction. Survey knowledge from the examine confirmed that greater than 80 % of the nurses in 4 states have been glad about scheduling practices at their hospital. Nonetheless, because the proportion of hospital nurses working shifts of greater than 13 hours elevated, patient' dissatisfaction with care elevated. Moreover, nurses working shifts of 10 hours or longer had been as much as 2.5 occasions extra probably than nurses working shorter shifts to expertise burnout, job dissatisfaction, and intent to depart the job.

And a 2014 examine within the American Journal of Essential Care discovered that nurses impaired by fatigue, lack of sleep, daytime sleepiness and a lack of ability to get well between shifts are extra doubtless than well-rested nurses to report choice remorse, an unfavorable cognitive emotion that happens when the precise result differs from the specified or anticipated consequence.

5. Workplace hazards. Nurses face a variety of workplace hazards every day whereas simply doing their jobs. These hazards embrace publicity to bloodborne pathogens, accidents, hand washing-related dermatitis and chilly and flu germs.

OSHA estimates 5.6 million out of roughly 12.2 million employees within the healthcare industry, and associated occupations are susceptible to occupational publicity to bloodborne pathogens.

And charges of workplace damage are larger in healthcare than different industries. Nurses expertise greater than 35,000 accidents involving the again, hands, shoulders and ft every year, by the Bureau of Labor Statistics. Many issues affect the probability of damage, together with age of the nurse and surroundings.

Apart from acute harm, nurses are additionally prone to suffer harm to their hands. Current research from the College of Manchester revealed healthcare employees following hand hygiene protocols are four.5 occasions extra prone to undergo reasonable to extreme pores and skin injury. In the identical examine, researchers discovered healthcare staff made up roughly 25 % of reported instances of irritant contact dermatitis.

Protecting nurses goes beyond their hands. As cold and flu season nears, hospitals and health techniques can put together to guard their workforce, together with additional measures for many who don't obtain the vaccinations for private or spiritual causes. One choice is having the nurses put on an antiviral face mask, which has been present to kill or inactivate 99.99 p.c of laboratory-tested flu viruses.

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Where is the best site for examining for the presence of petechiae in an African American client?

A. The abdomen
B. The thorax
C. The earlobes
D. The soles of the feet

Correct Answer: D






Explanation: Petechiae are not usually visualized on dark skin. The soles of the feet and palms of the hand provide a lighter surface for assessing the client for petechiae. Answers A, B, and C are incorrect because the skin may be too dark to make an assessment.

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Nursing Career Requirements

Nursing is mostly supplied as an affiliate's or bachelor's degree program. Proceed to study for a summary of the packages, in addition to profession and wage information for some profession choices for graduates.

In the event you like caring for individuals and are prepared to put the time into training, a career in nursing could also be for you. You may work towards certification and license for a profession as a licensed sensible nurse or a registered nurse. Nurses work in many various environments in addition to specializations offering the chance for a full and rewarding profession.

Nurse Education Requirements

After obtaining a high-school diploma or a GED, a student desirous of becoming a nurse selects from a range of educational choices. College students can select to pursue training to turn out to be licensed sensible nurses (LPNs) or registered nurses (RNs). An LPN can later enroll in additional classes to turn into an RN. Nurse training can come from school or hospital education schemes that result in a diploma, affiliate's degree or bachelor's degree. Diploma and associate's degree applications take much less time to finish however could supply fewer job opportunities after graduation.

Nursing programs feature a combination of class lectures, hands-on laboratory work, and medical expertise. College students take a course in anatomy, pathology, and microbiology. During clinical instruction, college students work below the supervision of professional nurses in a health care facility. Registered nurse applications usually embody extra in-depth examine than licensed sensible nurse packages.

Diploma and affiliate's degree programs last for about two years and can be found at community faculties and vocational schools. Faculties and universities supply bachelor's degree programs in nursing and final for four years. College students with an affiliate's degree can usually switch credit in the direction of a bachelor's degree in nursing.

Profession Requirements

All nurses are required to earn a state license by taking the Nationwide Council Licensure Examination provided by the Nationwide Council of State Boards of Nursing (www.ncsbn.org). Potential licensed sensible nurses to take the NCLEX-PN take a look at, whereas these are trying to grow to be registered nurses take the NCLEX-RN. Educational programs usually prepare college students to take these examinations. Particular person states might have extra necessities, so it is vital to verify with the licensing board for the state during which one is making use of to work.

Registered nurses with career specializations can provide additional services and discover additional job alternatives. Nurses can acquire credentials in particular health areas like dermatology or pediatrics. Specializations may come within the type of different work surroundings. For instance, vital care nurses work solely in critical care wards, and transport nurses help patients being transported from one space to a different. Credentials are earned by enrolling in additional educational programs and on-the-job training. If you're caring, compassionate and have a dedication to serving to folks, you will discover a function that fits you. You will also want to be able to talk tough health points effectively and courageously.

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Question Of The Day: Endocrine and Metabolic Disorders

Q. A nurse is caring for a client with poorly managed diabetes mellitus who has a serious foot ulcer. When she informs him that the physician has ordered a wound care nurse to examine his foot, the client asks why he should see anyone other than this nurse. He states, "It's no big deal. I'll keep it covered and put antibiotic ointment on it." What is the nurse's best response?

A. "We're very concerned about your foot and we want to provide the best possible care for you."
B. "This is a big deal and you need to recognize how serious it is."
C. "This is the physician's recommendation. The wound care nurse will see you today."
D. "You could lose your foot if you don't see the wound care nurse."

Correct Answer: A

Explanation: The client's response indicates that he's in denial and needs further insight and education about his condition. Letting the client know that the nurse has his best interests in mind helps him accept the wound-care nurse. Although telling the client that his condition is serious and that the wound care nurse will see him that day are true statements, they're much too direct and may increase client resistance. Telling the client he could lose his foot is inappropriate and isn't therapeutic communication.

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Impaired Physical Mobility Immobility: Nursing Care

Encourage and facilitate early ambulation and different ADLs when potential. Help with every preliminary change: dangling, sitting in a chair, ambulation. The longer the affected person stays motionless, the better the extent of debilitation that may happen.Facilitate switch training through the use of the applicable help of individuals or units when transferring patients to the mattress, chair, or stretcher.

Encourage appropriate use of assistive units within the residence setting. Mobility aids can enhance stage of mobility.Provide positive reinforcement throughout the exercise. Sufferers could also be reluctant to maneuver or provoke new exercise attributable to a concern of falling.

Enable patient to carry out duties at his or her personal price. Don't rush affected the person. Encourage impartial exercise as in a position and protected. Hospital staff and household caregivers are sometimes in a rush and do extra for sufferers than wanted, thereby slowing the patient’s restoration and lowering his or her vanity.

Keep side rails up and mattress in low place. 

This promotes a protected setting.Flip and place each 2 hours or as wanted. This optimizes circulation to all tissues and relieves strain.Keep limbs in useful alignment (e.g., with pillows, sandbags, wedges, or prefabricated splints). This prevents foot drop and extreme plantar flexion or tightness. Help ft in dorsiflexed place.

Use mattress cradle. 

This retains heavy mattress linens off ft. Carry out passive or lively assistive ROM workout routines to all extremities. Train promotes elevated venous return, prevents stiffness, and maintains muscle energy and endurance.

Promote resistance training providers. Analysis helps that energy coaching and different types of train in older adults can protect the flexibility to take care of impartial residing standing and cut back the danger of falling.

Turn patient to inclined or semi prone place as soon as every day until contraindicated. This drains bronchial tree.Use prophylactic anti pressure units as applicable. This prevents tissue breakdown.

Clean, dry, and moisturize skin as needed.

Encourage coughing and deep-breathing workouts. These forestall buildup of secretions.

Use suction as needed.

Use incentive spirometer. This will increase lung growth. Decreased chest excursions and stasis of secretions are related to immobility.

Encourage liquid consumption of 2000 to 3000 ml/day until contraindicated. Liquids optimize hydration standing and stop hardening of stool.

Initiate supplemental high-protein feedings as applicable.

If impairment outcomes from weight problems, provoke dietary counseling as indicated. Correct diet is required to take care of enough power degree.Arrange a bowel program (e.g., enough fluid, meals excessive in bulk, bodily exercise, stool softeners, laxatives) as wanted. Document bowel exercise degree.Administer medicines as acceptable. Antispasmodic drugs might scale back muscle spasms or spasticity that intervene with mobility.Educate energy-saving techniques. These optimize affected person’s restricted reserves.Help patient in accepting limitations. 

Nursing Skills:

 Explain progressive exercise to the patient. Assist patient or caregivers to determine affordable and obtainable targets.
 Instruct patient or caregivers relating to hazards of immobility. Emphasize significance of measures resembling place change, ROM, coughing, and workout routines.
 Reinforce rules of the progressive train, emphasizing that joints are to be exercised to the purpose of ache, not past. "No ache, no acquire" isn't all the time true!
 Instruct [patient/household relating to having to make dwelling surroundings protected. Protected surrounding is a prerequisite to improved mobility.
 Discuss with multidisciplinary health staff as applicable. Bodily therapists can present specialized providers.
 Encourage verbalization of feelings, strengths, weaknesses, and concern

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